CARDIAC SURGERY IN JEHOVAH'S WITNESSES: 337 CONSECUTIVE CASES

Abstract

<h3>Objective</h3> Cardiac surgery is associated with high rates of allogenic blood transfusion, due to the invasiveness of the procedures, perioperative blood loss and use of extracorporeal circulation. For their refusal of transfusion of any blood component, cardiac surgery in Jehovah's Witnesses can be a challenge. Over the last few decades, our hospital has developed as the national expertise centre for cardiac surgery in adult Jehovah's Witnesses. The aim of this study was to describe the outcome of the Jehovah's Witnesses undergoing cardiac surgery in our centre. <h3>Design and Method</h3> In this retrospective review, data of all Jehovah's Witnesses undergoing cardiac surgery in our hospital were collected from the 1st of January 2001 to the 31st of January 2022. Descriptive statistics were used to analyze obtained data. The institutional protocol describing all perioperative care in this special group has been applied for 21 years. Preoperative treatment consisted of pre-operative discontinuation of anticoagulant and antiplatelet therapy, erythropoietin, folic acid, vitamin B12 and iron therapy in case of anemia. Transfusion of blood components or medication of human origin were avoided and intra-operative blood collection via cell-saver and transfusion of autologous blood was used. <h3>Results</h3> The study cohort consisted of 337 Jehovah's Witnesses undergoing cardiac surgery. 69% were men and the mean age was 68 years. Twenty-three patients (6.8%) were treated for anaemia. The mean Euroscore was 5.1 (range 0-18). Surgery was elective in 72.9% and emergent in 2.7% of patients. Coronary Artery Bypass Grafting (54.1%) was performed most, followed by aortic valve replacements (18.6%). The mean operation time was 226 ± 134 minutes, with a mean extracorporeal circulation time of 88 ±51 minutes. Mean preoperative hemoglobin levels were 9 mmol/L (range 6.1-11.5 mmol/L), dropping to 7.2 mmol/L (range 4.1-9.9 mmol/L) at hospital discharge. Mean blood loss was 439 ± 349 mL in the first 12-hours post-surgery. Maximum mean postoperative troponin levels were 428 ± 422 ng/L. Rethoracotomy and myocardial infarction occurred in 3.6% and 4.2% of patients, respectively. In 4.2% cases, post-operative myocardial infarction was diagnosed. On average, patients had an intensive care unit stay of 1.4 ± 1.8 days and hospital stay of 6.8 ± 4.2 days. Hospital mortality was 0.6%. <h3>Conclusions</h3> This study demonstrates that cardiac surgery in Jehovah's Witnesses is safe when adhering to a strict perioperative patient blood management protocol, with a mortality of only 0.6%. Further research needs to be conducted to compare these outcomes to our general population and discover whether our strategy used in Jehovah's Witnesses could safely be extended to a wider population.